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Welcome Parents: 

Welcome Parents: 

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Published by api-20731342

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Published by: api-20731342 on Dec 22, 2009
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12/22/2009

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elcome Parents:
 
We are so glad to have your children be part of our new program. We arelooking forward to watching your children succeed and make new friends inour innovative socialization program.
 
e are forming a partnership with you for the benefit of your child. We willalways be available to answer your questions or concerns.
 
Best Regards,
 
Piera & Chris
 
Piera Bacolo (718) 605-6930Chris Caruso (718) 874-6109
 
ame of child: _________________________________________________ 
 
Date of birth: _________________ 
 
School child attends: _____________________________________________________
Parent’s name: _________________________________________________ 
 
ddress: ______________________________________________________ 
 
Phone Numbers
-
Home: _______________________________ 
 
ork: _______________________________ 
 
Cell: _______________________________ 
 
Email address: ________________________________________ 
 
How did you hear about us? _____________________________________ 
 
Please list any allergies child may have:
______________________________________________
 
Information Sheet
When was he/she diagnosed and what is the diagnosis?
__________________________________________
Is he/she on any medication?
_____________________________________________
What are his/her verbal capabilities? _______________________________________ How well does he/she follow verbal prompts/instructions? ___________________________________  ____________________________________________________________________________________ 
 
1. _________________________________________________  2. ________________________________________________  3. ________________________________________________  
Information about your child:
 
Please list any likes or dislikes your child may have:
 
In the box below, please tell us a little about your child:

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